Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 19, 2019
Date Accepted: May 20, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital interventions for younger children with chronic health conditions: which ones work and why? A systematic review
ABSTRACT
Background:
The prevalence of chronic health conditions in childhood is increasing, and behavioural interventions can support the management of these conditions. Digital interventions may be more cost-effective, appealing and accessible for users compared to face-to-face treatment, but there has been inadequate attention to their use with younger populations (children aged 5- 12 years).
Objective:
We had three aims: Aim 1) identify effective digital interventions, Aim 2) report the characteristics of promising interventions and Aim 3) describe the user’s experience of the digital intervention.
Methods:
We searched databases (EMBASE, PsycINFO, MEDLINE and the Cochrane Library) between January2014-January2019. The inclusion criteria for studies were: (1). Children aged 5-12-years of age, (2) intervention for behaviour change, (3) Randomised controlled trials, (4) digital interventions (5) chronic health conditions. Two researchers independently double-reviewed papers to assess eligibility, extract data and assess quality.
Results:
Databases searchers identified 2643 papers. We identified 17 eligible interventions. Aim 1) Five were promising (having a beneficial effect and with low risk of bias): three targeting overweight/obesity, using exergaming or social media, and two for anxiety, using online CBT. Aim 2) Characteristics of promising interventions included: gaming features, therapist support and parental involvement. Most were purely behavioural interventions (rather than CBT or third-wave), typically using the Behaviour Change Techniques “feedback and monitoring”, “shaping knowledge”, “repetition and substitution” and “reward”. Aim 3) We only identified three paper with qualitative data bout the users experience, we developed the themes: “parental involvement”, “Connection with a health professional is important for engagement”, “Technological affordances and barriers” and “Child-centred design”.
Conclusions:
Out of the 17 interventions, we only identified five with promise (those with a beneficial effect and low risk of bias). This low number of promising studies demonstrates that need for qualitative methods to improve acceptability, feasibility and child-centred design. We identified characteristics which could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioural (rather than cognitive) approaches, and particular BCTs (“feedback and monitoring”, “shaping knowledge”, “repetition and substitution” and “reward”). We suggest a model for improved conceptualisation and reporting of behavioural interventions involving the child and parent. Clinical Trial: The review was prospectively registered in the PROSPERO database: CRD42019122955 http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019122955
Citation
